Acquired Ventricular Septal Defect and Mitral Insufficiency Without Pericardial Effusion After Stab Wound to the Chest,☆☆,

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Abstract

Echocardiography has a role in the management of acute complications of penetrating cardiac trauma. We report the case of a 30-year-old man who sustained a stab wound to the chest. In this case a traumatic perforation of the ventricular septum and the anterior leaflet of the mitral valve caused by a knife occurred without pericardial effusion. The diagnosis was made by transthoracic echocardiography. The ability of transesophageal echocardiography to delineate the intracardiac injuries more precisely helped to guide the surgical procedure. (J Am Soc Echocardiogr 1998;11:483-6.)

Section snippets

Case Report

A 30-year-old man was taken to the emergency room after sustaining a stab wound from a knife to the chest. On arrival, he was in shock, with blood pressure of 45/30 mm Hg and heart rate of 80 bpm. The place of penetration was just medial to the left nipple. The chest radiograph showed a fluid collection in the left thorax with mediastinal shift. A chest tube was placed, and more than 750 ml of blood was drained. The patient was intubated and put on artificial respiration. He required a total of

Discussion

Gunshot and stab wounds are responsible for almost all penetrating cardiac injuries. Gunshot wounds have a higher mortality rate than stab wounds. Indications for emergency thoracotomy, techniques of cardiac injury repair, and adjunct maneuvers are beyond the scope of this report.3

The difficulty in evaluating different series on penetrating cardiac injuries along with analyzing their results has been pointed out by Trinkle.4 Although the incidence of intracardiac lesions in patients available

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From the Departments of Cardiology and Surgery, Sint Elisabeth Ziekenhuis, Tilburg; and the Department of Cardiothoracic Surgery, Catharina Ziekenhuis, Eindhoven.

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Reprint requests: W. Hans Pasteuning, MD, Department of Cardiology, Sint Elisabeth Ziekenhuis, Hilvarenbeekseweg 60, Postbus 90151, 5000 LC, Tilburg, The Netherlands.

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